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MeSH: nemoci arterie carotis-farmakoterapie

10 záznamů v Články Filtry

Článek

Antitrombotická léčba u onemocnění aorty a periferních tepen v roce 2021: konsenzuální dokument Pracovní skupiny ESC pro onemocnění aorty a periferních tepen, Pracovní skupiny ESC pro trombózu a Pracovní skupiny ESC pro kardiovaskulární farmakoterapii. Překlad dokumentu připravený Českou kardiologickou společností a Českou angiologickou společností ČLS JEP
[Antithrombotic therapies in aortic and peripheral arterial diseases in 2021: a consensus document from the ESC working group on aorta and peripheral vascular diseases, the ESC working group on thrombosis, and the ESC working group on cardiovascular pharmacotherapy. Translation of the document prepared by the Czech Society of Cardiology and the Czech Society of Angiology of ČLS JEP]

Cor et Vasa (Brno). 2021 ; 63 (6) : 748-759. [pub] 20211213

ISSN 0010-8650
Medvik
Zdroj

Autoři originálního textu European Society of Cardiology (ESC): V. Aboyans, R. Bauersachs, L. Mazzolai et al.Cílem tohoto dokumentu je poskytnout klinickým lékařům aktuální informace o nejlepší antitrombotické strategii u pacientů s onemocněním aorty a/nebo periferních tepen. Antitrombotická medikace je pilířem optimální léčby těchto pacientů s velmi vysokým kardiovaskulárním rizikem. Zatímco počet klinických studií antitrombotické léčby u pacientů s onemocněním aorty nebo periferních tepen je podstatně menší než u pacientů s ischemickou chorobou srdeční, nedávno získané důkazy si zaslouží být začleněny do klinické praxe. V případě absence indikace chronické perorální antikoagulace z důvodu jiného kardiovaskulárního onemocnění je u pacientů s onemocněním aorty nebo periferních tepen základem pro dlouhodobou antitrombotickou medikaci léčba jedním protidestičkovým lékem (SAPT). Kombinace této medikace s jiným protidestičkovým lékem nebo nízkou dávkou antikoagulancia budou probrány na základě pacientova rizika ischemie a krvácení, stejně jako další terapeutické postupy (např. endovaskulární terapie). Cílem tohoto konsenzuálního dokumentu je poskytnout návod pro antitrombotickou léčbu dle lokalizace onemocnění tepen a jeho klinické prezentace. Nemůže však nahradit multidisciplinární týmovou diskusi, která je zvláště důležitá u pacientů s nejistým poměrem rizika krvácení a ischemie. A protože se tento poměr u jednotlivých pacientů v průběhu času může měnit, nezbytné je pravidelné přehodnocení strategie antitrombotické terapie.

The aim of this collaborative document is to provide an update for clinicians on best antithrombotic strategies in patients with aortic and/or peripheral arterial diseases. Antithrombotic therapy is a pillar of optimal medical treat- ment for these patients at very high cardiovascular risk. While the number of trials on antithrombotic therapies in patients with aortic or peripheral arterial diseases is substantially smaller than for those with coronary artery disease, recent evidence deserves to be incorporated into clinical practice. In the absence of specific indications for chronic oral anticoagulation due to concomitant cardiovascular disease, a single antiplatelet agent is the basis for long-term antithrombotic treatment in patients with aortic or peripheral arterial diseases. Its association with another antiplatelet agent or low-dose anticoagulants will be discussed, based on patient's ischaemic and bleeding risk as well therapeutic paths (e.g. endovascular therapy). This consensus document aims to provide a guidance for antithrombotic therapy according to arterial disease localizations and clinical presentation. However, it cannot substitute multidisciplinary team discussions, which are particularly important in patients with uncertain ischaemic/bleeding balance. Importantly, since this balance evolves over time in an individual patient, a regular reassessment of the antithrombotic therapy is of paramount importance.

MeSH
antikoagulancia * terapeutické užití MeSH
inhibitory agregace trombocytů * terapeutické užití MeSH
lidé MeSH
nemoci arterie carotis farmakoterapie MeSH
onemocnění periferních arterií * farmakoterapie MeSH
trombóza farmakoterapie MeSH
Check Tag
lidé MeSH
Publikační typ
směrnice pro lékařskou praxi MeSH

Článek

Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial

Lancet. 2018 ; 391 (10117) : 219-229. [pub] 20171110

ISSN 1474-547X
Medvik
Zdroj

BACKGROUND: Patients with peripheral artery disease have an increased risk of cardiovascular morbidity and mortality. Antiplatelet agents are widely used to reduce these complications. METHODS: This was a multicentre, double-blind, randomised placebo-controlled trial for which patients were recruited at 602 hospitals, clinics, or community practices from 33 countries across six continents. Eligible patients had a history of peripheral artery disease of the lower extremities (previous peripheral bypass surgery or angioplasty, limb or foot amputation, intermittent claudication with objective evidence of peripheral artery disease), of the carotid arteries (previous carotid artery revascularisation or asymptomatic carotid artery stenosis of at least 50%), or coronary artery disease with an ankle-brachial index of less than 0·90. After a 30-day run-in period, patients were randomly assigned (1:1:1) to receive oral rivaroxaban (2·5 mg twice a day) plus aspirin (100 mg once a day), rivaroxaban twice a day (5 mg with aspirin placebo once a day), or to aspirin once a day (100 mg and rivaroxaban placebo twice a day). Randomisation was computer generated. Each treatment group was double dummy, and the patient, investigators, and central study staff were masked to treatment allocation. The primary outcome was cardiovascular death, myocardial infarction or stroke; the primary peripheral artery disease outcome was major adverse limb events including major amputation. This trial is registered with ClinicalTrials.gov, number NCT01776424, and is closed to new participants. FINDINGS: Between March 12, 2013, and May 10, 2016, we enrolled 7470 patients with peripheral artery disease from 558 centres. The combination of rivaroxaban plus aspirin compared with aspirin alone reduced the composite endpoint of cardiovascular death, myocardial infarction, or stroke (126 [5%] of 2492 vs 174 [7%] of 2504; hazard ratio [HR] 0·72, 95% CI 0·57-0·90, p=0·0047), and major adverse limb events including major amputation (32 [1%] vs 60 [2%]; HR 0·54 95% CI 0·35-0·82, p=0·0037). Rivaroxaban 5 mg twice a day compared with aspirin alone did not significantly reduce the composite endpoint (149 [6%] of 2474 vs 174 [7%] of 2504; HR 0·86, 95% CI 0·69-1·08, p=0·19), but reduced major adverse limb events including major amputation (40 [2%] vs 60 [2%]; HR 0·67, 95% CI 0·45-1·00, p=0·05). The median duration of treatment was 21 months. The use of the rivaroxaban plus aspirin combination increased major bleeding compared with the aspirin alone group (77 [3%] of 2492 vs 48 [2%] of 2504; HR 1·61, 95% CI 1·12-2·31, p=0·0089), which was mainly gastrointestinal. Similarly, major bleeding occurred in 79 (3%) of 2474 patients with rivaroxaban 5 mg, and in 48 (2%) of 2504 in the aspirin alone group (HR 1·68, 95% CI 1·17-2·40; p=0·0043). INTERPRETATION: Low-dose rivaroxaban taken twice a day plus aspirin once a day reduced major adverse cardiovascular and limb events when compared with aspirin alone. Although major bleeding was increased, fatal or critical organ bleeding was not. This combination therapy represents an important advance in the management of patients with peripheral artery disease. Rivaroxaban alone did not significantly reduce major adverse cardiovascular events compared with asprin alone, but reduced major adverse limb events and increased major bleeding. FUNDING: Bayer AG.

Článek

The association of masked hypertension in treated type 2 diabetic patients with carotid artery IMT

Diabetes research and clinical practice. 2010 ; 89 (3) : 239-42. [pub] 20100531

Diabetes Res Clin Pract
ISSN 1872-8227
Medvik
Zdroj

OBJECTIVES: To evaluate the association of masked hypertension (MH) in treated type 2 diabetic patients without history of cardiovascular disease with carotid artery target organ damage. METHODS: Sixty-four type 2 diabetic patients treated for hypertension with office BP below 140/90 mm Hg were examined by 24-h BP monitoring and carotid sonography. MH was diagnosed if daily mean ambulatory BP was >or=135/85 mm Hg. The association of MH with carotid artery parameters was evaluated. RESULTS: The average age of patients was 62+/-5 years. Twenty-four patients had MH (37.5%). Carotid artery IMT was 0.74+/-0.08 mm in patients with MH and 0.69+/-0.06 mm without MH (p=0.03). The distensibility of common carotid artery was 0.24+/-0.07 mmHg(-1) in patients with MH and 0.29+/-0.1mm Hg(-1) without MH (p=0.14). After adjustment for age, gender, smoking, duration of diabetes, BMI and clinic blood pressure (BP) values the association of MH with carotid artery IMT was sustained. CONCLUSION: Masked hypertension in treated type 2 diabetic patients is associated with carotid artery IMT.